Download Improving patient enablement and continuity of care in South Glos

Purpose: To create a culture of patient enablement in hospital,
through enhancing professional and organizational interfaces
and education.
Cathy Yuill
Emma Ellis
Hazel Lamb
Jo Skeets
IPECC Project Overview (HE SW)
Acute Hospital
Patient
Enablement
Trusted
Assessment
and Interface
Shared
DecisionMaking
Aim: Create an
enhanced culture of
patient enablement to
maintain functional
skills and independence
throughout an
individual’s acute stay
in hospital.
Aim: Develop a trusted
assessment process and
interface between
Nursing, Occupational
Therapy, Physiotherapy
and Social Work.
Aim: Improve the
interface and continuity
of care between
hospital and
community therapy and
Social Care services.
Functional Laminate
Discharge E-Learning
Practice-Based Teaching
Health Coaching
Enablement E-Learning
Practice-Based Enablement
Training
Purpose: To create a model of practice-based teaching
of enablement for Health Care Assistants working on the
acute wards.
What is enablement?
Enablement is supporting people,
not by doing things for them,
but by working in partnership with them
and encouraging them
to be as independent as possible.
Why Enablement?
• Prevent complications associated with
deconditioning – the vicious cycle!
Muscle Weakness
Chest infections
Pressure Sores
Increase risk of falls
Reduced Confidence
• Improved patient participation and
experience both in hospital and surrounding
discharge.
Practice Based Enablement Teaching
•
Piloted on two wards.
•
Meetings with HCA’s to identify learning needs.
•
Practice-based teaching on the ward with ‘real’ patients.
•
Role modelling/Lead by example.
•
Demonstration of competence.
Measurement
•
Pre- and post-training evaluation
•
Before and after observation of HCA practice.
•
Rated against behaviours that promote enablement.
•
Survey Monkey questionnaire before and after.
Summary Results: HCA Enablement Training on 9B
59.64% increase in
enabling indicators
sustained.
Baseline
TOTAL (mean
average - max 3)
In Summary: Enablement Behaviour Increased
0 – No evidence observed.
1 – Evidence observed less than 50% of the time.
2 – Evidence observed 50-75% of the time.
3 – Evidence observed over 75% of the time.
Before Training
1.43
After Training
2.57
One Month On
2.29
Percentage Increase
59.64%
Feedback From Staff
• - I feel much more confident to encourage people (I
am less afraid that they will fall).
• - I feel confident to explain to the patient about the
importance of enablement …. to speak to my
colleagues about enablement and the importance of
it.” (ward 9B)
• “I have learnt that it is important to give patients a
chance to do things for themselves, it helps them
for when they leave and it builds their confidence”
(ward 9A)
Health Coaching:
‘Enabling Conversations’
Purpose: Implemented practical training of the health
coaching framework, with a focus on Stroke Services.
Current Training as part of Health Coaching Pilot
• Health Coaching training provided to Therapists,
Nurses and HCAs on pilot wards.
• 2-day basic training + 2-day accreditation training.
• Portfolio development required for accreditation.
• Develop a ‘train-the-trainer’ programme using a
small group of clinicians who received this Health
Coaching training.
• Further staff receive health coaching training.
When patients see a clinician, their
consultation may not be working
• Only a third to a half of
patients comply with
prescribed medications and
10% with lifestyle advice.
• Only 60% of patients feel
they are sufficiently involved
in their care.
• Bennett H, Coleman E, Parry C, Bodenheimer,
2010
• KPMG Creating value with patients, carers and
communities 2014
• GMC Annual report 2013,
• Rhoades DR, Fam Med 2001.
• Wolever R, 2013
• Coulter A, 2011
• Not all clinicians are trained
in behaviour change.
Am I being
effective?
What is health coaching?
Helping patients gain the knowledge,
skills, tools and confidence to become
active participants in their care, so that they
can reach their self-identified health goals
Bodenheimer, 2010
Next Steps
• Developing a ‘roll-out plan’ to begin to embed a coaching
culture within the Trust, using the ‘Train-the-Trainer’
Health Coaching of staff
• Developing a process of evaluation (linking with AHSN
and UWE re possible research across the stroke
pathway)
• Linking with the ‘Patient Activation Measure’
• Linking with the STP in BNSSG, with alignment to MECC
(Making Every Contact Count)
Enablement E-Learning
Purpose:
Development of an e-learning training
programme on patient enablement. This is interactive,
and includes photographs and practical video clips. It
brings together all enablement information gathered as
part of the IPECC project.
The Functional Laminate
Pilot Ward 32a
Purpose: To pilot the development of a Patient Functional
Laminate on an acute ward for older people.
Feedback from staff and patients
• Link therapist reported that communication about
patient function between HCA staff and therapy staff
has improved.
• HCA staff reported the laminates were useful in caring
for patients providing they were up to date.
• Patients have been agreeable to have their functional
information on the whiteboard. One patient consented
to the laminate “if it helped”. Another patient
commented “if it helps me get out of hospital quicker”.
Discharge E-Learning:
Home is Best!
Purpose: Developed a Discharge E-Learning Training
Programme for acute clinical (and applicable to relevant
non-clinical) staff
© Learning and Development, August 2016
© Learning and Development, August 2016
© Learning and Development, August 2016
© Learning and Development, August 2016
For D2A Pathway 1
Is my patient safe between visits?
Count off the 5 key things to think about.
3. Access toileting
2. Access meds & food
Consider their mobility and function.
Do they need any equipment?
Do they have help at home?
4. Wash & dress
1. Access drink
5. Call for help
Consider their cognitive ability.
Will they understand the need to do these activities
at home?
Will they remember to do them?
Consider if the patient had any previous
support with these areas.
Consider any safeguarding concerns that need
to be addressed prior to discharge.
If you have any concerns, contact the
community team to discuss if Discharge to
Assess Pathway 1 can provide support.
© Learning and Development, August 2016
© Learning and Development, August 2016
© Learning and Development, August 2016
Project Risks and Issues
• Trust limitations and delays (e.g. winter pressures)
• Engagement of staff
• Time constraints due to trying to implement in a busy acute
hospital
• More detailed documentation to support patient enablement
• Funding to continue the Health Coaching Co-Delivery training
and roll-out of the ‘Enabling Conversations’ training
• Roll-out and continuation of each aspect of the project
© Learning and Development, August 2016
Any Questions?